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5.
<ul><li>TRENDS IN MATERNAL AND CHILD CARE </li></ul><ul><li>FAMILIES ARE SMALLER IN SIZE THAN IN PREVIOUS DECADES </li></ul><ul><li>SINGLE PARENTS ARE INCREASING IN NUMBER </li></ul><ul><li>AN INCREASING NUMBER OF MOTHERS ARE WORKING OUTSIDE THE HOME </li></ul><ul><li>FAMILIES ARE MORE MOBILE THAN PREVIOUSLY </li></ul><ul><li>ABUSE IS MORE COMMON THAN EVER BEFORE </li></ul><ul><li>FAMILIES ARE MORE HEALTH CONSCIOUS THAN EVER BEFORE </li></ul>

10.
E. GLANS CLITORIS = SMALL ERECTILE STRUCTURE; CONTAINS NERVE ENDINGS, SENSITIVE TO TEMPERATURE AND TOUCH . IT IS THE SEAT OF SEXUAL AROUSAL AND EXCITEMENT IN FEMALES . IT IS THE MOST SENSITIVE PART OF A WOMAN’S BODY . IT IS ALSO THE STRUCTURE THAT GUIDES THE NURSE TO THE URINARY MEATUS.

11.
F . URETHRAL MEATUS = THE EXTERNAL OPENING OF THE URETHRA. SLIGHTLY BEHIND AND TO THE SIDE ARE THE OPENINGS OF THE SKENE’S GLANDS ( PARAURETHRAL GLANDS ); THE SECRETIONS OF WHICH HELP TO LUBRICATE THE EXTERNAL GENITALIA. THE SHORTNESS OF THE FEMALE URETHRA MAKES WOMEN MORE SUSCEPTIBLE TO UTI THAN MEN. G . HYMEN . = A TOUGH BUT ELASTIC SEMICIRCLE OF TISSUE THAT COVERS THE OPENING TO THE VAGINA. THE REMNANT OF HYMEN IS CALLED CARUNCULAE MYRTIFORMIS.

14.
H. VAGINAL ORIFICE / INTROITUS = EXTERNAL OPENING OF THE VAGINA, COVERED BY A THIN MEMBRANE ( HYMEN) IN VIRGINS.LOCATED LATERAL TO THE VAGINAL OPENING ON BOTH SIDES ARE THE BARTHOLIN’S GLANDS ( VULVOVAGINAL GLANDS ). IT LUBRICATES THE EXTERNAL VULVA DURING COITUS AND THE ALKALINE PH OF THEIR SECRETION HELPS TO IMPROVE SPERM SURVIVAL IN THE VAGINA. THE GRAFENBERG OR G-SPOT IS A VERY SENSITIVE AREA LOCATED AT THE INNER ANTERIOR ASPECT OF THE VAGINA.

21.
<ul><li>RUGAE – TRANSVERSE FOLDS OF SKIN IN THE VAGINAL WALL THAT IS ABSENT IN CHILDHOOD, APPEAR AFTER PUBERTY & DISAPPEARS AT MENOPAUSE. </li></ul><ul><li>FORNIX-FORNICES= THE CERVIX PROJECTS TO THE VAGINA FORMING FOUR RECESSES OR DEPRESSION AROUND ITS UPPER PORTION CALLED FORNICES: ANTERIOR FORNIX, LATERAL FORNICES, POSTERIOR FORNIX. </li></ul>

22.
B. UTERUS = HOLLOW, MUSCULAR PEAR SHAPED ORGAN LOCATED IN THE PELVIS, WEIGHING 50-60 g IN A NON-PREGNAT WOMAN. HELD IN PLACE BY BROAD LIGAMENTS. ABUNDANT BLOOD SUPPLY COMES FROM UTERINE AND OVARIAN ARTERIES.

28.
<ul><li>= MOST VASCULAR PORTION </li></ul><ul><li>= NORMAL IMPLANTATION SITE </li></ul><ul><li>3. CORPUS – BODY OF THE UTERUS WHICH MAKES UP 2/3 OF THE SAID ORGAN. HOUSES THE FETUS DURING PREGNANCY </li></ul><ul><li>4. CORNUA – THE UPPER PORTION WHERE THE FALLOPIAN TUBES ARE ATTACHED. </li></ul><ul><li>LAYERS : </li></ul><ul><li>1. PERIMETRIUM </li></ul><ul><ul><li>= OUTERMOST LAYER, IT IS ATTACHED TO THE BROAD LIGAMENTS & OFFER ADDED SUPPORT TO THE UTERUS </li></ul></ul>

29.
<ul><li>= MOST VASCULAR PORTION </li></ul><ul><li>= NORMAL IMPLANTATION SITE </li></ul><ul><li>3. CORPUS – BODY OF THE UTERUS WHICH MAKES UP 2/3 OF THE SAID ORGAN. HOUSES THE FETUS DURING PREGNANCY </li></ul><ul><li>4. CORNUA – THE UPPER PORTION WHERE THE FALLOPIAN TUBES ARE ATTACHED. </li></ul><ul><li>LAYERS : </li></ul><ul><li>1. PERIMETRIUM </li></ul><ul><ul><li>= OUTERMOST LAYER, IT IS ATTACHED TO THE BROAD LIGAMENTS & OFFER ADDED SUPPORT TO THE UTERUS </li></ul></ul>

30.
2. MYOMETRIUM = MIDDLE LAYER , EXPELS FETUS DURING BIRTH PROCESS THEN CONTRACTS AROUND BLOOD VESSELS TO PREVENT HEMORRHAGE (OXYTOCIN SITE) 3. ENDOMETRIUM = INNERMOST LAYER; THIS LAYER UNDERGO CHANGES IN RESPONSE TO THE HORMONES AT VARIOUS PHASES OF THE MENSTRUAL CYCLE & DURING PREGNANCY; IT CONSISTS OF TWO LAYERS:

32.
UTERINE LIGAMENTS : 1.BROAD LIGAMENT – SUPPORTS THE SIDES OF THE UTERUS & ASSISTS IN HOLDING THE UTERUS IN ITS NORMAL ANTEVERSION AND ANTEFLEXION POSITION.

37.
2. CARDINAL LIGAMENT – LOWER PORTION OF THE BROAD LIGAMENT. IT IS THE MAIN SUPPORT OF THE UTERUS.DAMAGE TO THIS LIGAMENT WILL RESULT TO UTERINE PROLAPSE .

39.
3. UTEROSACRAL LIGAMENT – CONNECTS UTERUS TO THE SACRUM 4. ANTERIOR LIGAMENT – PROVIDES SUPPORT TO THE UTERUS IN CONNECTION WITH THE BLADDER. OVERSTRETCHING OF THIS LIGAMENT WILL LEAD TO HERNIATION OF THE BLADDER TO THE VAGINA ( CYSTOCELE). 5. POSTERIOR LIGAMENT – FORMS THE CUL-DE-SAC OF DOUGLAS. DAMAGE TO THIS LIGAMENT WILL LEAD TO HERNIATION OF THE RECTUM TO THE VAGINA. ( RECTOCELE )

40.
C. FALLOPIAN TUBES / OVIDUCTS / UTERINE TUBES = TWO SLENDER MUSCULAR TUBES WHICH ARISES FROM EACH OF THE UPPER CORNER OF THE UTERINE BODY AND EXTEND OUTWARD. PROVIDES A PLACE FOR FERTILIZATION ( CONCEPTION, FECUNDATION, IMPREGNATION) OF OVA BY THE SPERM.

44.
<ul><li>FUNCTION: </li></ul><ul><ul><li>TRANSPORT OVUM FROM OVARY TO THE UTERUS </li></ul></ul><ul><ul><li>SITE OF FERTILIZATION </li></ul></ul>

45.
D. OVARIES = ALMOND SHAPED ORGANS LOCATED ON EITHER SIDE OF THE UTERUS. BEFORE PUBERTY, THE OVARIES ARE SMOOTH, FLAT & OVOID ORGANS. AFTER OVULATIONS, THEY ASSUME A NODULAR & PITTED APPEARANCE. FUNCTIONS: = RESPONSIBLE FOR THE PRODUCTION, MATURATION AND DISCHARGE OF OVA AND SECRETION OF ESTROGEN AND PROGESTERONE = ORGAN OF OVULATION

48.
<ul><li>LAYERS OF THE OVARY : </li></ul><ul><li>TUNICA ALBUGINEA </li></ul><ul><li>- THE OUTERMOST PROTECTIVE LAYER SURROUNDED BY A SINGLE LAYER OF CUBOIDAL EPITHELIUM . </li></ul><ul><li>2. CORTEX </li></ul><ul><li>- THE FUNCTIONAL LAYER WHICH IS THE SITE OF OVUM FORMATION & MATURATION. IT CONTAINS THE PRIMORDIAL FOLLICLES, GRAAFIAN </li></ul>

50.
<ul><li> THE MAMMARY GLANDS </li></ul><ul><li>STRUCTURES: </li></ul><ul><li>LOBES =EACH BREAST CONSISTS OF 15-20 LOBES FOUND IN EACH BREAST WHICH ARE SUBDIVIDED INTO LOBULES </li></ul><ul><li>LOBULES – COMPOSED OF CLUSTERS OF ACINAR CELLS ( RESPONSIBLE FOR MILK PRODUCTION) </li></ul>THE FEMALE BREASTS ARE ACCESSORY ORGANS OF REPRODUCTION MEANT TO PROVIDE THE INFANT WITH THE MOST IDEAL NOURISHMENT AFTER BIRTH.

53.
PHYSIOLOGY OF MILK PRODUCTION ** THE PRODUCTION OF BREAST MILK IS NOT ACHIEVED DURING PREGNACY BECAUSE OF THE PREDOMINANCE OF ESTROGEN & PROGESTERONE. ** IMMEDIATELY AFTER THE DELIVERY OF THE PLACENTA, THERE IS MARKED DECREASE OF BOTH ESTROGEN & PROGESTERONE W/C SERVES AS A STIMULUS FOR THE APG TO PRODUCE PROLACTIN . ** PROLACTIN ACTS ON THE ACINI CELLS TO STIMULATE PRODUCTION OF MILK & ARE THEN STORED IN THE LACTIFEROUS DUCTS.

54.
** AS THE INFANT SUCKS, THE PPG IS STIMULATED TO RELEASE THE HORMONE OXYTOCIN CAUSING THE COLLECTING SINUSES OF THE MAMMARY GLANDS TO CONTRACT, FORCING MILK FORWARD THROUGH THE NIPPLES CALLED “ LET DOWN REFLEX ” OR “ MILK EJECTION REFLEX ” .

55.
<ul><li>HORMONES THAT INFLUENCE THE MAMMARY GLANDS: </li></ul><ul><ul><li>ESTROGEN – STIMULATES THE DEVELOPMENT OF THE DUCTILE STRUCTURES OF THE BREST </li></ul></ul><ul><ul><li>PROGESTERONE – STIMULATES THE DEVELOPMENT OF THE ACINAR CELLS </li></ul></ul><ul><ul><li>HUMAN PLACENTAL LACTOGEN – PROMOTES BREAST DEVELOPMENT DURING PREGNANCY </li></ul></ul><ul><ul><li>OXYTOCIN – LET DOWN REFLEX </li></ul></ul><ul><ul><li>PROLACTIN – STIMULATE MILK PRODUCTION </li></ul></ul>

61.
<ul><li>FUNCTIONS OF THE TESTES : </li></ul><ul><li>SPERMATOGENESIS </li></ul><ul><li>= PROCESS BY WHICH THE SPERMATOCYTES ARE DEVELOPED INTO MATURE SPERMATOZOA </li></ul><ul><li>2. HORMONE PRODUCTION </li></ul><ul><li>a. T ESTOSTERONE = AN ANDROGEN OR MUSCULINIZING HORMONE RESPONSIBLE FOR </li></ul><ul><li>** GROWTH & DEVELOPMENT OF SECONDARY SEX CHARACTERISTICS </li></ul>

64.
MALE REPRODUCTIVE SYSTEM: <ul><li>B. Internal Structures </li></ul><ul><ul><li>1. Epididymis : serves as reservoir for sperm storage and maturation. Approximately 20 ft. it takes 12-20 days for the sperm to travel the length of Epididymis. </li></ul></ul><ul><ul><li>A total of 64 days before they reach maturity. </li></ul></ul><ul><ul><li>(“Treatment= 2 months” ). </li></ul></ul><ul><ul><ul><li>Aspermia - (absence of sperm) </li></ul></ul></ul><ul><ul><ul><li>Oligospermia- if < 20 million sperm/ ml </li></ul></ul></ul><ul><ul><li>2. Vas deferens : a duct extending from epididymis to the ejaculatory duct and seminal vesicle, providing a passageway for sperm. </li></ul></ul><ul><ul><ul><li>Varicocele- varicosity of internal spermatic cord </li></ul></ul></ul><ul><ul><ul><li>Vasectomy (male birth control) </li></ul></ul></ul><ul><ul><li>3. Seminal vesicle : are two convoluted pouches that lie along the lower portion of the bladder and empty into the urethra by the way of ejaculatory ducts </li></ul></ul>

65.
MALE REPRODUCTIVE SYSTEM: 4. Ejaculatory duct : the canal formed by the union of the vas deferens and the excretory duct of the seminal vesicle, which enters the urethra at the prostate gland. 5. Prostate Gland : located just below the urinary bladder. Secretes alkaline and most of the seminal fluid. 6. Bulbourethral glands or Cowper’s Gland : adds alkaline fluid to the semen. Counterpart of the Bartholin’s glands in females. 7. Urethra : the passageway for both urine and semen, extending from the bladder to the urethral meatus . (8 inches in long)

66.
SEMINAL FLUID / SEMEN : = A GRAYISH WHITISH SUBSTANCE CONTAINING SPERMATOZOA AND FRUCTOSE RICH SUBSTANCES. = AT THE TIME OF EJACULATION, APPROXIMATELY 3-5 ML OF SEMEN IS SECRETED WITH ABOUT 100 MILLION SPERMATOZOA PER ML, OR ABOUT 250-500 MILLION SPERMATOZOA AT EACH EJACULATION. IF THE SPERM COUNT DROPS TO LESS THAN 20 MILLION PER ML OF SEMEN, THE RATE IS CONSIDERED INFERTILE .

75.
MENSTRUAL CYCLE / FEMALE REPRODUCTIVE CYCLE = EPISODIC UTERINE BLEEDING IN RESPONSE TO HORMONAL CHANGES = PERIODIC SERIES OF CHANGES THAT RECUR IN THE UTERUS AND ASSOCIATED ORGANS BEGINNING AT PUBERTY AND ENDING AT MENOPAUSE = TAKEN FROM THE FIRST DAY OF MENSTRUATION TO THE FIRST DAY OF THE NEXT MENSTRUATION

76.
Basis for menstrual cycle is 6-12 month graphing. Menarche – first menstrual period that occurs typically at age 12 but may occur as early as 9 or as late as 17. Thelarche – is the development of the breast buds that occur at puberty. Adrenarche – is the development of pubic & axillary hair due to androgen stimulation.

77.
<ul><li>MENSTRUATION = PERIODIC, SLOUGHING OFF OF THE ENDOMETRIUM WHICH OCCURS EVERY 28 DAYS BUT COULD BE ANYWHERE FROM 25 TO 35 DAYS & LASTS FOR 3-5 DAYS. </li></ul><ul><li>Characteristic of Menstrual Blood: </li></ul><ul><li>Does not appear to clot </li></ul><ul><li>Dark red as that of venous blood </li></ul><ul><li>Offensiveness ( Fleshy stale odor) </li></ul>

78.
<ul><li>BODY STUCTURES INVOLVED IN MENSTRUATION ; </li></ul><ul><li>HYPOTHALAMUS – ultimate initiator of menstrual cycle. Secretes GnRH. Releases FSHRF during the first half of the cycle & LHRF during the second half of the cycle. </li></ul><ul><li>2. ANTERIOR PITUITARY GLAND – releases the gonadotropin hormones (GH) FSH & LH </li></ul><ul><li>3. OVARIES - site of ovulation & releases estrogen & progesterone. </li></ul><ul><li>4. UTERUS – the organ from which menstrual discharge is formed. The changes in the uterine endometrium are due to ovarian hormones </li></ul>

80.
<ul><li>Diseases of the hypothalamus causing a deficiency of this releasing factor can result in delayed puberty. Diseases causing early activation of the GnRH can lead to abnormally early sexual development or precocious puberty </li></ul>

83.
Uterine Cycle : Menstrual phase <ul><li>Day 1- day 5 </li></ul><ul><li>First day of bleeding is the first day of cycle </li></ul><ul><li>Stratum functionale is shed </li></ul><ul><li>Total blood loss during menses range from 30-80 ml. 60 ml average! </li></ul><ul><li>More than 80ml blood loss is considered excessive- need for iron supplements </li></ul><ul><li>Ave daily loss of iron is 0.5 to 1mg </li></ul>

84.
Uterine cycle : proliferative Phase ( estrogenic, follicular ) <ul><li>Day 6- day 14 of a 28 day cycle </li></ul><ul><li>The very low estrogen level during menstruation stimulates hypothalamus to secrete FSHRF, which in turn stimulates the APG to secrete FSH </li></ul><ul><li>Estrogen is lowest on the 3 rd day of the menstrual cycle & highest a day before ovulation </li></ul>

87.
Uterine cycle : Ischemic phase <ul><li>If fertilization does not occur, the corpus luteum shrivels as its life span is only 8-10 days from date of ovulation. On the 26 th day of a 28 day cycle, if pregnancy has not occurred, the corpus luteum begins to degenerate and becomes corpus albicans . Two days after, menstruation occurs </li></ul>

94.
<ul><li>3. The distensible quality of the cervical mucus wherein it becomes profuse and thin and can be pulled into long strands & suspended like in two glass slides is called SPINNBARKEIT . </li></ul><ul><li>Spinnbarkeit test – does not indicate the exact time of ovulation but signals that a woman is nearing ovulation. This sign is characterized by cervical mucus that is thin, watery and transparent, abundant and highly stretchable . When dried and viewed under the microscope, the mucus reveals a fern pattern . The fern pattern is due to elevated levels of sodium chloride. </li></ul>

96.
4. Cervical Changes <ul><li>Ferning or arborization of cervical mucus </li></ul><ul><li>At the height of estrogen stimulation just before ovulation </li></ul><ul><li>Ferning - due to crystallization of sodium chloride on mucus fibers </li></ul>

97.
5. Basal Body Temperature <ul><li>Involves taking the temperature every morning BEFORE the woman gets out of bed and recording it </li></ul><ul><li>The temperature drops slightly 24 hours before ovulation, then rises to about half a degree higher than normal and remains thus for up to three days: UNSAFE period! </li></ul><ul><li>Not a very efficient method unless combined with calendar and mucus methods </li></ul>

108.
<ul><li> FETAL DEVELOPMENT </li></ul><ul><li>OVUM : </li></ul><ul><li>IT IS THE FEMALE SEX CELL OR FEMALE GAMETE. </li></ul><ul><li>REGULARLY RELEASED BY THE OVARY BY OVULATION </li></ul><ul><li>ONLY ONE OVUM REACHES MATURITY EVERY MONTH </li></ul><ul><li>4. OVUM HAS 2 LAYERS OF PROTECTIVE COVERING ; A RING OF FLUID CALLED“ ZONA PELLUCIDA ”, & A CIRCLE OF CELLS CALLED “ CORONA RADIATA ” </li></ul><ul><li>= these structures increase the bulk of the ovum, facilitating its migration to the uterus. </li></ul>** MATUR

109.
** OVUM CAN STAY VIABLE & IS CAPABLE OF BEING FERTILIZED FOR 12-24 HOURS AFTER OVULATION BUT CAN LIVE UP TO 3-4 DAYS. ** MATUR

110.
<ul><li>** ONLY ONE SPERMATOZOON IS ABLE TO PENETRATE THE CELL MEMBRANE OF THE OVUM AFTERWHICH THE OVUM BECOMES IMPERVIOUS TO OTHER SPEMATOZOA. </li></ul><ul><li>2 KINDS OF SPERM CELL: </li></ul><ul><li>GYNOSPERM – X CARRYING SPERM CELL. It has a large oval head, lesser in number than androsperms & thrive better in acidic environment. </li></ul><ul><li>ADROSPERM – Y CARRYING CELL. It has a small head & thrive better in alkaline environment </li></ul>

112.
** HAS 3 PARTS : HEAD THAT CONTAIN CHROMATIN MATERIALS; NECK OR MID PIECE THAT PROVIDE ENERGY & TAIL THAT IS RESPONSIBLE FOR ITS MOTILITY. **SPERMATOZOA DEPOSITED IN THE VAGINA REACHES THE WAITING EGG IN THE FALLOPIAN TUBE IN ABOUT 5 MINUTES ** THE FUNCTIONAL LIFE OF SPERMATOZOA IS 48-72 HRS (OR 3 TO 4 DAYS AFTER EJACULATION) BUT CAN STAY ALIVE IN THE VAGINA FOR 5 -7 DAYS. SPERM CELL : .

113.
Insemination <ul><li>Deposition of the sperm in the female internal organs which occur during sexual intercourse </li></ul><ul><li>Although millions of sperms are deposited in the vagina, only a few reach the uterus because many of them are immobilized by the acidic vaginal environment </li></ul>

114.
<ul><li>FERTILIZATION ( CONCEPTION, FECUNDATION, IMPREGNATION) </li></ul><ul><li>= IT IS THE UNION OF A MATURED EGG AND A SPERM & THE PRODUCT IS CALLED A CONCEPTUS OR ZYGOTE . </li></ul><ul><li>=IT OCCURS AT THE DISTAL 3 RD OF THE FALLOPIAN TUBE – THE AMPULLA </li></ul><ul><li>Before fertilization can happen, two things must occur: </li></ul><ul><li>Ovulation </li></ul><ul><li>Insemination </li></ul>

115.
** When the sperm cell reaches the uterus, it removes its protective covering, a process called “ CAPACITATION” , the outer covering at the head of the sperm cell disappears & tiny holes appear on it. ** when it meets the ovum in the fallopian tube it secretes the enzymes HYALURONIDASE through the holes in its head which dissolves the outermost covering of the egg cell, the corona radiata (a process called “ ACROSOME REACTION ”.) ** when radiata is dissolved, the sperm will again secrete another enzyme called ACROSIN to dissolve a portion of the zona pellucida & will enter the ovum.

116.
** once the sperm cell has entered the ovum & their nucleus has fused together, fertilization is completed . ** the plasma membrane of the ovum will undergo structural changes to prevent POLYSPERMY ( or other sperms cells entering the ovum) ** the hereditary traits & characteristics of a person are found in the cell’s nucleus in the form of chromosomes. Each strand of chromosome is made up of thousands of genes that are composed of protein substances called deoxyribose nucleic acid (DNA) & ribonucleic acid (RNA)

118.
** ( BODY CELLS OR SOMATIC CELLS HAVE 46 CHROMOSOMES BEC THEY DIVIDE VIA MITOSIS) ** SPERMS HAVE 23 CHROMOSOMES = 22 AUTOSOMES & 1 X SEX CHROMOSOME OR 1 Y SEX CHROMOSOME. ** THE UNION OF AN X CARRYING SPERM (GYNOSPERM) & A MATURE OVUM RESULTS IN A BABY GIRL (XX) ** THE UNION OF A Y CARRYING SPERM(ANDROSPERM) & A MATURE OVUM RESULTS IN A BABY BOY (XY) ** ONLY FATHERS CAN DETERMINE THE SEX OF THEIR CHILDREN ** SEX OF A CHILD IS DETERMINED AT THE TIME OF FERTILIZATION.

119.
<ul><li>Genes – basic units of heredity that detrmine both the physical and cognititve characteristics of people </li></ul><ul><li>Phenotype – refers to his or her outward appearance or the expression of the genes </li></ul><ul><li>Genotype – refers to his or her actual gene composition </li></ul><ul><li>Genome – complete set of genes present </li></ul><ul><ul><li>46XX or 46XY </li></ul></ul>

121.
ZYGOTE : - IS THE FIRST CELL FORMED FROM THE FERTILIZATION OF SPERM & OVUM. - IT CONTAINS 46 CHROMOSOMES: 44 AUTOSOMES & EITHER XX CHROMOSOMES IF THE OFFSPRING IS A FEMALE, OR XY CHROMOSOME, IF THE OFFSPRING IS A MALE. - IT JOURNEYS FROM THE FALLOPIAN TUBE TO THE UTERUS FOR 3-5 DAYS - 16 HOURS AFTER FERTILIZATION, IT UNDERGOES ITS FIRST CELL DIVISION ,” BLASTOMERE”

124.
- WHEN THERE ARE ALREADY 16 OR MORE BLASTOMERES, THE ZYGOTE IS TERMED “ MORULA ”( MORUS – MULBERRY) - WHEN IT REACHES THE UTERUS IT IS TRANSFORMED INTO A “ BLASTOCYST ” – A BALL LIKE STRUCTURE COMPOSED OF AN INNER CELL MASS , CALLED EMBRYONIC DISC OR BLASTOCELE & AN OUTER LAYER OF RAPIDLY DEVELOPING CELLS CALLED TROPHOBLASTS OR TROPHODERM. FLUID FILLS THE SPACES FOUND WITHIN THE CELLS. -

126.
<ul><li>The trophoderm layer gives rise to the placenta, fetal membranes, umbilical cord and amniotic fluid </li></ul><ul><li>The important functions of the trophoblasts are to: </li></ul><ul><li>1) absorb nutrients from the endometrium </li></ul><ul><li>2.) secrete a hormone called “ Human Chorionic Gonadotropin ” necessary in prolonging the life of the corpus luteum. </li></ul>

128.
1.HCG: HUMAN CHORIONIC GONADOTROPIN - FIRST HORMONE TO APPEAR IN PREGNANCY WHICH SERVES AS THE BASIS FOR PREGNANCY TESTING - SECRETED BY TROPHOBLASTS DURING EARLY PREGNANCY - PREVENTS INVOLUTION OF THE CORPUS LUTEUM, STIMULATES IT TO CONTINUE PRODUCING PROGESTERONE AND ESTROGEN FOR 11-12 WEEKS - 8 – 10 DAYS AFTER FERTILZATION, HCG IS PRESENT IN THE MATERNAL BLOOD - FEW DAYS AFTER MISSED MENSES (+) IN THE URINE

130.
<ul><li>3. Estrogen </li></ul><ul><li>- stimulates development of uterine and breast tissues in the mother </li></ul><ul><li>- increases vascularity and vasodilation in the villous capillaries </li></ul>

131.
<ul><li>4. Progesterone </li></ul><ul><li>- after 11 weeks of pregnancy, placenta takes over the production of progesterone from the corpus luteum </li></ul><ul><li>- it is a smooth muscle relaxant, prevents uterine contraction by decreasing its contractility </li></ul><ul><li>- also maintains the endometrium </li></ul>

133.
- At the time of implantation, the blastocyst already has differentiated at which two separate cavities appear in the inner structure.1. a large one, the Amniotic cavity which is lined with ECTODERM cells 2. a smaller cavity, the yolk sac, lined with ENDODERM cells ( provides fetal RBC until the embryo’s hematopoietic system matures on the 12 th week after which it atrophies) - Between the amniotic cavity and the yolk sac, a third layer of cells, the MESODERM forms . The embryo will begin to develop at the point where the three cell layers ( ECTODERM, MESODERM, ENDODERM) meet called embryonic shield.

137.
<ul><li>FETAL MEMBRANES : - </li></ul><ul><li>= this enclose the fetus & the amniotic fluid. They also protect the fetus against ascending bacterial infection. Once the integrity of the membranes are destroyed, the woman is prone to develop infection. </li></ul><ul><li>CHORIONIC MEMBRANE – ( OUTER MEMBRANE) = TOGETHER WITH THE DECIDUA BASALIS GIVES RISE TO THE PLACENTA . IT CONTAINS 15-20 COTYLEDONS . </li></ul>

141.
IMPLANTATION/NIDATION - THE BLASTOCYST REMAINS FREE FLOATING IN THE UTERINE CAVITY FOR 3-5 DAYS & IMPLANTS IN THE ENDOMETRIUM 6-7 ( 8-10 ) DAYS AFTER FERTILIZATION. - AS IT ATTACHES ITSELF TO THE WALL OF THE UTERUS ( APPOSITION ), ITS TROPHOBLAST CELLS RELEASE ENZYMES ALLOWING IT TO BURROW DEEP & THEN ATTACHES INTO THE ENDOMETRIUM ( ADHESION ) RESULTING IN RUPTURE OF VESSELS & BLEEDING AT THE IMPLANTATION SITE. “ IMPLANTATION BLEEDING ”. AFTERWHICH IT SETTLES DOWN INTO ITS SOFT FOLDS ( INVASION) IMPLANTA

142.
<ul><li>IMPLANTATION IS AN IMPORTANT STEP IN PREGNANCY BECAUSE AS MANY AS 50% of zygotes never achieve it. </li></ul>

143.
<ul><li>DECIDUA: </li></ul><ul><li>- AFTER IMPLANTATION, THE ENDOMETRIUM IS NOW REFERRED TO AS THE DECIDUA . </li></ul><ul><li>LAYERS: </li></ul><ul><li>DECIDUA BASALIS – LAYER WHERE IMPLANTATION TAKES PLACE. IT WILL LATER ON FORM THE MATERNAL SIDE OF THE PLACENTA. </li></ul><ul><li>DECIDUA CAPSULARIS – LAYER WHICH ENCLOSES, ENVELOPES THE BLASTOCYST & BECOMES THE BAG OF WATER. </li></ul><ul><li>. DECIDUA VERA – REMAINING LAYER </li></ul>

153.
<ul><li>CORD INSERTION : </li></ul><ul><li>*1. CENTRAL INSERTION – NORMALLY, THE CORD IS INSERTED AT THE CENTER OF THE FETAL SURFACE OF THE PLACENTA. </li></ul>

154.
<ul><li>*2. LATERAL INSERTION – WHEN THE CORD IS INSERTED AWAY FROM THE CENTER OF THE PLACENTA BUT NOT AT ITS EDGES. </li></ul>

155.
3. Velamentous insertion of the cord <ul><li>The cord, instead of entering the placenta directly, separates into small vessels that reach the placenta by spreading across a fold of amnion </li></ul><ul><li>May be found in multiple gestation </li></ul><ul><li>May be associated with fetal anomalies </li></ul>MLNG CELESTE, RN, MD

156.
* 4. Battledore insertion <ul><li>The cord is inserted marginally rather than centrally </li></ul><ul><li>The cord is inserted at the edge of the placenta </li></ul>

158.
Cord Abnormalities <ul><li>Knots of the Cord – fetal movements may cause knots in the cord which could lead to perinatal loss. Its incidence is high in monoamniotic twinning. Normal false knots results from kinking to accommodate cord length. </li></ul><ul><li>Loops of the Cord- the cord may coil around the fetal body and neck. When cord coil is in the neck, it is called nuchal cord . </li></ul>

160.
THE PLACENTA IS FORMED FROM THE CHORIONIC VILLI AND DECIDUA BASALIS . ** ITS GROWTH PARALLELS THAT OF THE FETUS, GROWING FROM A FEW IDENTIFIABLE CELLS AT THE BEGINNING OF PREGNANCY TO AN ORGAN 15 TO 20 CM IN DIAMETER. IT COVERS ABOUT HALF OF THE SURFACE OF THE INTERNAL UTERUS * IT REACHES MATURITY AT 8 WEEKS AND BECOMES FUNCTIONAL AT 12 WEEKS GESTATION ( 3 MONTHS) AND CONTINUE TO FUNCTION EFFECTIVELY UNTIL THE 40 TO 41ST WEEK.. IT BEGINS TO DEGENERATE AFTER THE 42ND WEEK MAKING IT DANGEROUS FOR THE FETUS TO REMAIN IN UTERO BEYOND 42 WEEKS GESTATION. * DEVELOPMENT IS STIMULATED BY PROGESTERONE SECRETED BY THE CORPUS LUTEUM PLACENTA

161.
<ul><li>Placenta - membranous vascular organ connecting the fetus to the mother, supplies the fetus with oxygen and food and transports waste product out of fetal system </li></ul><ul><li>- development is stimulated by progesterone secreted by corpus luteum </li></ul><ul><li>( 3 rd wk after fertilization) </li></ul><ul><li>- fully functional by the 12 th week </li></ul>

162.
<ul><li>2 sides of placenta: </li></ul><ul><li>1.maternal side which is irregular and is divided into subdivisions called cotyledons </li></ul><ul><li>2. fetal side covered by amnion, so it is smooth and shiny </li></ul>

164.
FUNCTIONS OF THE PLACENTA 1. RESPIRATORY SYSTEM = EXCHANGE OF GASES TAKES PLACE IN THE PLACENTA, NOT IN THE FETAL LUNG 2. RENAL SYSTEM = WASTE PRODUCTS ARE BEING EXCRETED THROUGH THE PLACENTA NOTE: IT IS THE MOTHER’S LIVER WHICH DETOXIFIES THE FETAL WASTE PRODUCTS 3. GASTROINTESTINAL SYSTEM = NUTRIENTS PASS TO THE FETUS VIA THE PLACENTA BY DIFFUSION THROUGH THE PLACENTAL TISSUES.

168.
Anomalies of the placenta and cord <ul><li>Placenta </li></ul><ul><li>Weighs approximately 500 g and is 15 – 20 cm in diameter, 1.5 – 3 cm thick </li></ul><ul><li>Weight is 1/6 of the fetus </li></ul><ul><li>Maternal and fetal sides </li></ul><ul><li>Umbilical cord </li></ul><ul><li>length:55 cm at term </li></ul><ul><li>1 vein (carries oxygenated blood to the fetus) </li></ul><ul><li>2 arteries (carry deoxygenated blood from fetus to placenta) </li></ul><ul><li>Wharton’s jelly, gelatinous substance </li></ul><ul><li>Cord extends from the fetal surface of the placenta to the fetal umbilicus </li></ul>

169.
Placenta succenturiata <ul><li>Placenta has 1 or more accessory lobes connected to the main placenta by blood vessels </li></ul>

170.
Placenta circumvallata <ul><li>Ordinarily, chorion membrane begins at the edge of the placenta; no chorion covers the fetal side of the placenta </li></ul><ul><li>This kind- the fetal side of the placenta is covered with chorion </li></ul>

171.
Abnormal Placental Implantation <ul><li>Placenta Acreta – invasion of the placenta deep into the endometrium </li></ul><ul><li>Placeta increta- invasion of the placenta into the myometrium </li></ul><ul><li>Placenta percreta – penetration of the placenta through the myometrium to the serosa </li></ul><ul><li>Vasa previa – placental vessels crossing the cervical os </li></ul>

179.
24 WEEKS PASSIVE ANTIBODY TRANSFER FROM MOTHER TO FETUS BEGINS .INFANTS BORN BEFORE ANTIBODY . TRANSFER HAS TAKEN PLACE HAVE NO NATURAL IMMUNITY & NEED MORE THAN THE USUAL PROTECTION AGAINST INFECTIOUS DISEASE IN THE NEWBORN UNTIL THE INFANT’S OWN STORE OF IG’S CAN BUILD UP; MECONIUM IS PRESENT IN THE RECTUM; ACTIVE PRODUCTION OF LUNG SURFACTANT BEGINS; EYEBROWS & EYELASHES WELL DEFINED; EYELIDS NOW OPEN; PUPILS REACTIVE TO LIGHT; HEARS IN RESPONSE TO SUDDEN SOUND. L = 28 TO 36 CMS W= 550g

180.
28 WEEKS LUNG ALVEOLI BEGINS TO MATURE; SURFACTANT PRESENT IN AMNIOTIC FLUID; TESTES BEGIN TO DESCEND;BLOOD VESSELS OF THE RETINA ARE THIN & EXTREMELY SUSCEPTIBLE TO DAMAGE ( an imp. consideration when caring for preterm infants who need oxygen) 32 SUBCUTANEOUS FAT BEGINS TO BE DEPOSITED ( THE FORMER “ STRINGY” OLD MAN APPEARANCE IS LOST); FETUS IS AWARE OF SOUNDS OUTSIDE THE MOTHERS BODY; ACTIVE MORO REFLEX PRESENT, BIRTH POSITION( VERTEX OR BREECH) MAY BE ASSUMED; IRON STORES THAT PROVIDE IRON FOR THE TIME THAT THE NEONATE WILL INGEST ONLY MILK AFTER BIRTH ARE BEGINNING TO BE DEVELOPED; FINGERNAILS GROW TO REACH END OF FINGERTIPS. weeks

181.
36 WEEKS ADDITIONAL AMOUNTS OF SUBCATANEOUS FATS ARE DEPOSITED ; SOLE OF THE FOOT HAS ONLY ONE OR TWO CRISSCROSS CREASES; LANUGO BEGINS TO DIMINISH; MOST BABIES TURN INTO A VERTEX OR HEAD-DOWN PRESENTATION DURING THIS MONTH 40 WEEKS FETUS KICKS ACTIVELY CAUSING DISCOMFORT TO THE MOTHER; VERNIX CASEOSA IS FULLY FORMED; ** IN PRIMIPARAS, THE FETUS OFTEN SINKS INTO THE BIRTH CANAL DURING THE LAST TWO WEEKS ( UP TO 4 WEEKS), GIVING THE MOTHER A FEELING THAT HER LOAD IS BEING LIGHTENED. THIS IS TERMED LIGHTENING . IT IS A FETAL ANNOUNCEMENT THAT THE THIRD TRIMESTER OF PREGNANCY HAS ENDED AND BIRTH IS AT HAND.** L-48 to 52 cm W-3,000g -7 to 7.5 lbs

182.
** THE DURATION OF A NORMAL PREGNANCY IS 266 – 280 DAYS OR 38-42 WEEKS ( AVERAGE IS 40 WEEKS) ; OR 9 CALENDAR MONTHS OR 10 LUNAR MONTHS. ** BOTH OVULATION & GESTATIONAL AGE ARE ALSO SOMETIMES MEASURED IN LUNAR MONTHS ( 4 WEEK PERIODS) OR IN TRIMESTERS ( 3 MONTH PERIOD) RATHER THAN IN WEEKS. IN LUNAR MONTHS, A PREGNANCY IS 10 MONTHS ( 40 WEEKS OR 280 DAYS) LONG; A FETUS GROWS IN UTERO 9.5 LUNAR MONTHS OR THREE FULL TRIMESTERS ( 38 WEEKS OR 266 DAYS)

186.
SKIN <ul><li>Pink or reddish abdominal streaks ( striae gravidarum ) which is caused by stretching of the skin </li></ul><ul><li>Chloasma or “mask of pregnancy -Increased pigmentation can occur on the face as blotchy brown areas on the forehead an cheeks </li></ul><ul><li>linea nigra – on the abdomen as dark line from the symphysis pubis </li></ul><ul><li>Minute vascular spiders may occur </li></ul><ul><li>The umbilicus is pushed outward, and by about the seventh month its depression disappears and becomes a darkened area on the abdominal wall </li></ul><ul><li>Sweat and sebaceous glands are more active </li></ul>

189.
<ul><li>POSITIVE SIGNS OF PREGNANCY : </li></ul><ul><li>( DEFINITELY PREGNANT) </li></ul><ul><li>PRESENCE OF FETAL HEART TONE- audible bet. 17-20 wks gestation with the use of ordinary stet audible by doppler at 8 to 10 weeks </li></ul><ul><li>2. FETAL OUTLINE BY XRAY / ULTRASOUND – may be detected as early as the 6 th wk AOG although usually done at 16-18 wks </li></ul><ul><li>3. FETAL MOVEMENT FELT BY EXAMINER – after 16 wks but usually about 5 th month </li></ul>

190.
SYSTEMIC CHANGES: CIRCULATORY / CARDIOVASCULAR : ** BEGINNING THE END OF THE FIRST TRIMESTER, THERE IS A GRADUAL INCREASE OF ABOUT 30%-50% IN TOTAL CARDIAC VOLUME. THIS CAUSES A DROP IN HgB & HcT VALUES SINCE THE INCREASE IS ONLY IN PLASMA .” PHYSIOLOGIC ANEMIA OF PREGNANCY” Mx : iron supplement

191.
CONSENQUENCES OF INCREASED CARDIAC VOLUME: ** EASY FATIGABILITY & SOB DUE TO INCREASED WORKLOAD OF THE HEART MX: REST ** SLIGHT HYPERTHOPHY OF THE HEART CAUSING IT TO BE DISPLACED TO THE LEFT ** SYSTOLIC MURMURS DUE TO LOWERED BLOOD VISCOSITY ** NOSEBLEEDS MAY OCCUR DUE TO MARKED CONGESTION OF THE NASOPHARYNX

192.
** PALPITATIONS DUE TO INCREASED PRESSURE ON THE DIAGPHRAGM ** EDEMA OF LOWER EXTERMITIES OCCURS DUE TO POOR CIRCULATION RESULTING FROM PRESSURE OF THE GRAVID UTERUS ON THE BLOOD VESSELS MX; > RAISE LEGS ABOVE HIP LEVEL > AVOID PROLONGED STANDING & SITTING NOTE: EDEMA OF THE LE IS NOT A SIGN OF TOXEMIA.

193.
** VARICOSITIES COULD OCCUR DUE TO PRESSURE OF THE GRAVID UTERUS ON THE BLOOD VESSELS OF THE LE MX: > DO NOT CROSS LEGS WHEN SITTING > WEAR SUPPORT HOSE TO PROMOTE VENOUS FLOW THUS PREVENTING STASIS IN THE LOWER EXTREMITIES > AVOID USE OF KNEE HIGH SOCKS

194.
** VARICOSITIES OF THE VULVA & RECTUM MX: > SIDE LYING POSITION WITH HIPS ELEVATED ON PILLOWS > MODIFIED KNEE CHEST POSITION ** THERE IS INCREASED CIRCULATING FIBRINOGEN ( CLOTTING FACTOR) THAT IS WHY PREGNANT WOMEN ARE NORMALLY SAFEGUARDED AGAINST UNDUE BLEEDING. HOWEVER THIS ALSO PREDISPOSES THEM TO CLOT FORMATION ( THROMBI)

195.
IMPLICATION : PREGNANT WOMEN SHOULD NOT BE MASSAGED SINCE BLOOD CLOTS CAN BE RELEASED & CAUSE THROMBOEMBOLISM. ** DURING DELIVERY, THE ALLOWABLE BLOOD LOSS IS 250-450 ML (MAXIMUM 500 ML) FOR A SINGLE FETUS, 1000 ML FOR VAGINAL DELIVERY OF TWINS OR CESARIAN SECTION.

196.
** SUPINE HYPOTENSION SYNDROME OR VENA CAVA SYNDROME = THE WEIGHT OF THE GRAVID UTERUS PRESSES ON THE VENA CAVA OBSTRUCTING BLOOD FLOW. THE WOMAN EXPERIENCES LIGHTHEADEDNESS , FAINTNESS & HEART PALPITATIONS . MX: LEFT SIDE LYING OR LEFT LATERAL SO AS NOT TO COMPRESS THE VENA CAVA. NO SUPINE POSITION AFTER 20 WEEKS AOG

200.
HEARTBURN = REFLUX OF STOMACH CONTENT INTO THE ESOPHAGUS DUE TO INCREASED PROGESTERONE WHICH DECREASES GASTRIC MOTILITY MX: > PATS OF BUTTER BEFORE MEALS > AVOID FRIED, FATTY FOODS > BEND AT THE KNEES NOT AT THE WAIST > TAKE ANTACIDS EX. MILK OF MAGNESIA BUT NEVER SODIUM NHCO3 ( ALKA SELTZER OR BAKING SODA) BECAUSE IT PROMOTES FLUID RETENTION. > DON’T LIE DOWN AFTER EATING

201.
PICA = **ABNORMAL CRAVING FOR NON NUTRITIOUS SUBSTANCES. THE MOST COMMON IS CRAVING FOR ICE CUBES. THERE COULD ALSO BE CRAVING FOR PAPER, ETC., **OFTEN ACCOMPANIES IRON DEFICIENCY ANEMIA **ENCOURAGE TO TAKE IRON SUPPLEMENTS

202.
MUSCULOSKELETAL SYSTEM GRADUAL SOFTENING OF PELVIC LIGAMENTS AND JOINTS TO FACILITATE PASSAGE OF THE BABY. ( RELAXIN) LORDOSIS = FORWARD CURVATURE OF THE LUMBER SPINE . “THE PRIDE OF PREGNANCY ” LEG CRAMPS – ALSO KNOWN AS “CHARLEY HORSE” MAY OCCUR FROM AN IMBALANCE OF CALCIUM / PHOSPHORUS RATIO IN THE BODY AND FROM PRESSURE OF THE UTERUS ON LOWER EXTREMITIES; FATIGUE; CHILLS BACK PAINS – RELIEVED BY WEARING LOW HEELED SHOES